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Background <p>Human papillomavirus (HPV) is a double-stranded DNA virus and a necessary cause of cervical cancer. Persistent infection with high-risk (HR) HPV genotypes, particularly HPV-16 and HPV-18, drives cervical neoplasia. In Zambia, cervical cancer incidence remains high, yet data on the spatial distribution and determinants of HPV infection in Western Province are limited.</p> Methods <p>A cross-sectional study was conducted between October 2025 and January 2026 among 1,132 women aged 15–70 years attending healthcare facilities in Western Province. Participants were recruited using a facility-based consecutive sampling approach, whereby all eligible women presenting during the study period were invited to participate until the target sample size was achieved. This approach ensured feasibility and reduced selection bias within healthcare settings. Cervical samples were obtained through provider- or self-collection and analyzed using the Hologic Panther system for high-risk human papillomavirus (HR-HPV) detection and genotyping. Sociodemographic, behavioral, and contextual data were collected using structured questionnaires. Multilevel mixed-effects logistic regression was used to assess determinants of HR-HPV infection, and spatial analysis was performed using QGIS.</p> Results <p>Overall HR-HPV prevalence was 34%. Single infections predominated, with HPV-18 (35%) and HPV-16 (32%) being the most common genotypes, while double and triple infections occurred in 12% and 7% of cases, respectively. Age-specific prevalence demonstrated a bimodal pattern, with peaks observed among women aged 25–34 years and those aged ≥ 55 years. Several factors were significantly associated with HR-HPV infection, including multiple lifetime sexual partners (aOR = 14.02), high parity (&gt; 5 children; aOR = 6.38 ), unvaccinated status (aOR = 5.79), single marital status (aOR = 2.41), low HPV knowledge (aOR = 7.05 ), hormonal contraceptive use (aOR = 5.03), and living with HIV (aOR = 2.63–5.94). Attendance at rural health facilities was also associated with higher odds of infection (aOR = 13.31). Although several associations were strong, some estimates had wide confidence intervals and should be interpreted with caution. Spatial analysis demonstrated significant geographic heterogeneity in HPV prevalence across districts.</p> Conclusion <p>HR-HPV infection in Western Province is high and geographically heterogeneous, with certain districts bearing a disproportionate burden. These findings highlight the need for targeted, data-driven interventions. Strengthening HPV vaccination programs, particularly early vaccination (ages 9–14) before sexual debut, and expanding catch-up campaigns in underserved areas should be prioritized. High-burden and rural districts require intensified screening, outreach, and health system strengthening, including improved diagnostic capacity and workforce support. Given the strong association between HIV and HR-HPV, integrating HPV services into HIV care platforms is essential. Additionally, scaling up community-based education will improve awareness, promote safer practices, and increase vaccine uptake.</p>

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Spatial distribution and determinants of high risk human papillomavirus infection among women in Western Province Zambia

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月9日

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  • Masiliso A. Liamba,
  • David Chisompola,
  • Eric Namataa,
  • Benson M. Hamooya,
  • Grace Kahenya,
  • Sepiso K. Masenga

摘要

Background

Human papillomavirus (HPV) is a double-stranded DNA virus and a necessary cause of cervical cancer. Persistent infection with high-risk (HR) HPV genotypes, particularly HPV-16 and HPV-18, drives cervical neoplasia. In Zambia, cervical cancer incidence remains high, yet data on the spatial distribution and determinants of HPV infection in Western Province are limited.

Methods

A cross-sectional study was conducted between October 2025 and January 2026 among 1,132 women aged 15–70 years attending healthcare facilities in Western Province. Participants were recruited using a facility-based consecutive sampling approach, whereby all eligible women presenting during the study period were invited to participate until the target sample size was achieved. This approach ensured feasibility and reduced selection bias within healthcare settings. Cervical samples were obtained through provider- or self-collection and analyzed using the Hologic Panther system for high-risk human papillomavirus (HR-HPV) detection and genotyping. Sociodemographic, behavioral, and contextual data were collected using structured questionnaires. Multilevel mixed-effects logistic regression was used to assess determinants of HR-HPV infection, and spatial analysis was performed using QGIS.

Results

Overall HR-HPV prevalence was 34%. Single infections predominated, with HPV-18 (35%) and HPV-16 (32%) being the most common genotypes, while double and triple infections occurred in 12% and 7% of cases, respectively. Age-specific prevalence demonstrated a bimodal pattern, with peaks observed among women aged 25–34 years and those aged ≥ 55 years. Several factors were significantly associated with HR-HPV infection, including multiple lifetime sexual partners (aOR = 14.02), high parity (> 5 children; aOR = 6.38 ), unvaccinated status (aOR = 5.79), single marital status (aOR = 2.41), low HPV knowledge (aOR = 7.05 ), hormonal contraceptive use (aOR = 5.03), and living with HIV (aOR = 2.63–5.94). Attendance at rural health facilities was also associated with higher odds of infection (aOR = 13.31). Although several associations were strong, some estimates had wide confidence intervals and should be interpreted with caution. Spatial analysis demonstrated significant geographic heterogeneity in HPV prevalence across districts.

Conclusion

HR-HPV infection in Western Province is high and geographically heterogeneous, with certain districts bearing a disproportionate burden. These findings highlight the need for targeted, data-driven interventions. Strengthening HPV vaccination programs, particularly early vaccination (ages 9–14) before sexual debut, and expanding catch-up campaigns in underserved areas should be prioritized. High-burden and rural districts require intensified screening, outreach, and health system strengthening, including improved diagnostic capacity and workforce support. Given the strong association between HIV and HR-HPV, integrating HPV services into HIV care platforms is essential. Additionally, scaling up community-based education will improve awareness, promote safer practices, and increase vaccine uptake.